Facebook YouTube X (Twitter) Instagram Flocknote

Funeral Worksheet

- This form is not accepting responses at this time.
  
  Funeral Directors are asked to submit the following information at least 48 hours prior to the date of funeral services. Please call 724-265-2070 with any questions.
  
  Today's Date REQUIRED Please fill out this field. Please enter a date.
  
  Name of Deceased REQUIRED Please fill out this field. Please enter valid data.
  
  Age of Deceased REQUIRED Please fill out this field. Please enter an integer (number).
  
  Date of Death REQUIRED Please fill out this field. Please enter a date.
  
  Contact Information
  
  Name of Nearest Relative or Contact Person REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Deceased REQUIRED Please fill out this field. Please enter valid data.
  
  Contact Address REQUIRED Please fill out this field.
  
  Contact Phone Number REQUIRED
  
  Please fill out this field. Please enter a phone number.
  
  Funeral Service Information
  
  Funeral Home in charge of arrangements REQUIRED Please fill out this field.
  
  Viewing Information or Comments
  
  Preferred Date and Time of Vigil Service at Funeral Home (if requested by family) Please enter valid data.
  
  If Vigil Services are requested by the family, the parish office and parish Funeral Ministry will coordinate it with the Ladies of Charity.
  
  Requested Funeral Service Date REQUIRED Please fill out this field. Please enter a date.
  
  Requested Funeral Service Time REQUIRED Please fill out this field. Please enter valid data.
  
  Type of Funeral Service REQUIRED Please fill out this field.
  
  When preparing the obituary, Funeral Directors are asked to please indicate in the funeral notice and obituary the name and location of the specific church at which the funeral Mass will be celebrated. Our Lady of the Lakes Parish consists of both Saint Victor Church (Bairdford) and Transfiguration Church (Russellton).
  
  Disposition of Remains REQUIRED Please fill out this field.
  
  Cemetery/Mausoleum/Columbarium REQUIRED Please fill out this field. Please enter valid data.
  
  Interment/Inurnment Information REQUIRED Please fill out this field.
  
  Is the Parish Center Activity Building needed for a funeral luncheon? REQUIRED Please fill out this field.
  
  When at all possible, we will offer the Activity Building on the Saint Victor Campus free of charge to families for a funeral luncheon. If there is a schedule conflict with the hall, a member of the Funeral Ministry Team will communicate that to the family.
  
  Submit